JTuxu 29, 1895.] THE MEDICAL INSTITUTIONS OF LONDON. [TM1a. 1451 2 I myself strongly incline to the view that an infintesimal alleged specific fouling of their waters by that case lends amount of the poison of enteric fever in drinking water is itself to corroborate the strong probability that the outbreak eufficient to cause the disease in those consuming the water. was in fact thus brought about. Indeed we know, from eminent bacteriological research, We have seen already in milk outbreaks of typhoid how a that the bacillus of enteric fever is, when present in water, great many of those using the infected milk escape the dis- there only in proportion relatively small; and that the ease, not because they are not susceptible to the disease, but organism even when present in water in the bulk, may be on account of the fact that the infective germs of the fever entirely absent from the small quantity submitted for exa- are not uniformly distributed in the milk, hiouseholds thus in mination. And again, other microbes may be present so many instances receiving milk free from the dangerous in- numerously in typhoid-polluted water as to render obscure, gredients which are contained in that supplied to, it may be, and even to prevent recognition of, the scantily present the very next house to which the milk is taken. May it not bacilli of typhoid fever. This was prominently brought for- well be so with water in reference to the germs of typhoid? ward in the case of the Worthing outbreak of 1893. (See also Professor Koch has stated that when enteric fever is found AppendiX A.); and again finds place in the report of the to be occurring in largely increasing quantity over an area Royal Commission on Metropolitan Water Supply. On the supplied with the same water and unconnected case with case, question of the amount of polluting material necessary to it will be well to seek for evidence of water as the cause. induce typhoid as the result of consumption of water, Pro- In any case, pending the settlement of the vexed ques-ion fessor Odling seems to regard " a very considerable dose " as of the direct relation between rivers and typhoid as cause -essential; and others appear to hold the same view. But Dr. and effect, would it not be best to take the excellent advice Sims Woodhead admits that in respect of typhoid, knowledge offered by the late Sir George Buchanan ? I refer to his state- on this point is not definite. He even says that the entry ment that if populations are so situate that they must needs into a domestic cistern of one single specimen of the bacillus pollute the river on whose banks they reside, the river should of typhoid might, by reason of multiplication in the cistern, be frankly recognised as unclean. prove a danger to all the household consuming the water. " Thus," he says, " regarding rivers as sources of drinking Coming to an actual occurrence, additional to that water, one of two positions ought, I submit, to be consist- of Caterham, where the evacuations of a single typhoid ently aimed at-either that, being a necessary source of patient may be regarded as in all probability the start- domestic water supply, the river shall be absolutely pro- ing point, indeed, the vera causa of an alarming epidemic tected against pollution; or else that, being (in whatever of the same disease, I would here like to draw special degree) used as a sewer, it shall be classed as not fit to supply attention to the prevalence of the malady at Black- drinking water." burn in 1881. The outbreak embraced in all 260 attacks in For the rest as regards this particular instance of the Tees the period February to May of that year (No. 128),- and Dr. epidemic, I am content to know that the chief medical Airy, in his careful and elaborate report, sets forthwith great adviser of the State on public health matters, Dr. Thorne clearness the details of the occurrence. I shall have occasion Thorne, has (as previously stated) said, in presenting the at a later stage to refer at greater length to this instance of report which Dr. Barry made upon it, that " seldom, if ever, waterborne typhoid, but treating of it here from the point of has a case of the fouling of water intended for human con- view of great harm following small beginnings, I will leave sumption, so gross or so persistently maintained, come for the time the general question of water consumption and within the cognisance of the Medical Department, and fever as cause and effect. seldom, if ever, has the proof of the relation of the use of Dr. Airy records how, in his opinion, the dejecta from a the water so befouled to wholesale occurrence of enteric fever single case of typhoid at Shorrock's Row, Guide, shown in been more obvious and patent." the plan given at a later stage, gave rise to the epidemic. He [To be continuel.] puts out at some little length how the drainage of the privy, into which the dejecta were Cast, could have found its way into the reservoirs which supplied Blackburn. The case was one of undoubted typhoid, and the evacuations had carbolic acid cast over them by an unskilled labourer, neither the BRITISH MEDICAL ASSOCIATION.' health officer or nuisance inspector proceeding to the spot, despite the fact that the town water service was palpably SIXTY-THIRD ANNUAL MEETING THE endangered at the place of occurrence. The attack was cer- OF tified on February 22nd. A reference to the plan will show BRITISH MEDICAL ASSOCIATION the manner in which the public supply was threatened, and IN LONDON, 1895. when I have occasion to mention this outbreak on a later page, I shall have to point out the extreme liability of the cul- vert furnishing water to the borough to pollution from the THE MEDICAL INSTITUTIONS OF LONDON. row of houses in which this case was treated. I need not (Continued from page 138)1.) follow Dr. Airy through the successive paragraphs in which he seeks to prove that the Blackburn water was liable to THE RISE AND FALL OF THE PRIVATE MEDICAL contamination by these specif£c excreta; let it suffice when I SCHOOLS IN LONDON. state in his own words that " it appears that in the latter part of February every section of the water supply of Black- By D'ARcy PowEB, M.A., F.R.C.S.Eng., burn contained more or less of the water that had passed Demonstrator of Surgery at St. B%rtholomew's Hospital; and Surgeon to through the conduit under Shorrock's Row. Therefore, sup- the Victoria Hospital for Children. posing the conduit water at that time to be the vehicle of IV.-BRooKxSIs SCHOOL, OR THE BLENHEIM STREET OR enteric fever, we can see how a general outbreak of fever in GREAT MARLBOROUGH STREET SCHOOL. the early part of March in different parts of the town might BROOKES's SCHOOL was a private speculation of Joshua be accounted for." Now there were three reservoirs to which Brookes, the brother of the celebrated menagerie keeper in the drainings of the dejecta could have found their way- Exeter 'Change. He was born November 24th, 1761, and was namely, Guide, with acapacity of 90,000,000 gallons; Fishmoor a student of the Great Windmill Street School; and he after- Lodge, 310,000,000 gallons; and Audley, 12,000,000 gallons. wards studied under Portal in Paris. His school was situated Wme are told that the second had only 50,000,000 gallons in it in what is now known as Ramilies Street, at the foot of *h*u Dr. Airy was there, so that there could not have been Blenheim Steps in Oxford Street, and was the last building -poX than a total of 152,000,000 gallons at most when the in- on the left beyond the Mews as one goes down the steps quiry was held; but how much less is not told us. Here by the side of Buszard's shop, just before turning into tbhu is an outbreak undoubtedly due to waterborne infection, Great Marlborough Street. The school was established Xd4i; which detailed inquiry enables only one attack to be solely to teach anatomy, and the summer course wias loohe upon as the origin of the large epidermic among a vast especially well attended ; for Brookes had invented, a body' ot people drinking from three different storage reser- method of injecting his. subjects with nitre,, which fitted vois, whose relationship at a time coinciding with the them for dissection in the hot, weather, wheni tlere 1452 TEaJOzA] THE MEDICAL INSTITUTIONS OF LONDON. [JUNE 29, 189&

Brookes's School (from a water-colour drawing made June, 1817, now in the possession of the Royal College of Surgeons of England). were no regular classes in the large medical schools attached V.-DERMOTT's SCEOOL: THE GIERRARD STREBET OB LiTrm to the hospitals. For this method he was made a Fellow of WINDMILL STREET SCHOOL OF MEDICINB. the Royal Society. Mr. South says that he literally spent This school originated directly out of Brookes's school, for the whole of his day in the dissecting room, and that he taught Dermott had been an assistant in the Blenheim Street School his students entirely from dissected parts. using neither for a year or two before Brookes died. This event happenec plates, diagrams, nor blackboard sketches. He worked with in 1833, a fortnight before the session opened, and as Dermott such assiduitythat hewasrecognised throughoutEurope as the was unable to obtain possession of the premises, he bought. best anatomical teacher in London. He also had the reputation the lease of the house in Little Windmill Street (now Lex- of being the dirtiest professional person it was possible to ington Street) which stood the second or third building on conceive; his good report always preceded him, and his the left from Brewer Street. He contracted with a builder filthy hands begrimed his nose with continual snuff. " In to alter the house in fourteen days in such a way as to fit it his ordinary appearance I really know," says Mr. South, "no for an anatomical school; by personal superintendence of dirty thing with which he could compare; all and every part the workmen, by having night and day shifts, and by giv- of- him was dirt, and his house was no cleaner than his ing them as much beer as they could drink he used to boast person; yet he sometimes came out as a pleasant gentlemanly that thc* work was completed within the stipulated tin,., person in black with a powdered head, cleanish hands, yet and the school was opened at the beginning of the session. snuffy withal, and not lacking in good manners and informa- George Derby Dermott, who thus became its proprietor, tion." It was this reputation, doubtless, which prevented was of Irish extraction-the son of a medical practitioner in him from being elected a member of the Council of the Royal Northamptonshire, who afterwards left medicine and became College of Surgeons-a position for which he was eminently a Wesleyan minister-and he had acquired almost as con- fitted by his attainments in anatomy and in the operative summate a knowledge of anatomy as Joshua Brookes him- parts of surgery. It was his hobby to form a museum of self. He was not a great physiologist, and of practical sur- comparative osteology; in pursuit of it-and helped by his gery he knew nothing. He died of renal disease, aged 45, on brother, the menagerie keeper-he converted into skeletons September 12th, 1847. The late Mr. J. F. Clarke, in his auto- every animal upon which he could lay his hands. The two biographical sketches, gives an interesting and amusing ac- upper storeys of his house formed his museum, and his rooms count of Dermott's peculiarities. He was very unpunctual as to. were so crammed with prejparations that it was hardlypossible the time of beginning his lectures. His afternoon discourse to move in them without knocking something over. usually occupied two hours, and if he observed symptoms of The College of Surgeons declined to recognise a summer weariness in his audience, he would say, " Gentlemen, you course of anatomical lectures after the year 1824, and from that are fatigued with your labours; let us have a little interlude time Brookes's school, like Carpue's, began to decline, until to revive you." He would leave off demonstrating the from a class of 120 to 150 it dwindled to a few pupils, and he muscles of the thigh for a few minutes, and give us the was compelled to sell his museum piecemeal-a proceeding soliloquy of Hamlet or the death scene in Richard III, which occupied no fewer than twenty-three days, commencing amidst the enthusiastic applause of his audience. He would on March 1st, 1830. He died in Great Portland Street on then finish his demonstration. He was convivial to a fault, January 10th, 1833, just before the opening of the session, and took great delight in inviting his class to his house without a single shilling, everything having been spent in on certain evenings to "drink punch and smoke." He amassing his osteological collection. He was so poor, in fact, generally accompanied his invitation to these meeUngs that, a subscription was raised to pay his funeral expenres. with some remarks on the advantages of keeping within 5uw 29, Itff.I THE METROPOLITAN WATER SUPPLY. [KIDIoAL 1453 reasonable bounds with respect; to the quantity of punch his THE TEACHINGS OF PROFESSOR E. FRANK- guests were to imbibe. " But," he would observe. " I do not wish to be inhospitable; I wish every, man to enjoy himself LAIND'S REPORT ON METROPOLITAN under my roof. And, gentlemen, if any of you or all of you WATER SUPPLY, 1894. after leaving my residence has or have the misfortune to be intercepted on the way to your lodging, send for me and I By CHARLES PORTER, M.D.IREL., D.P.H.CAMB., will bail you. I make it a point not to go to bed early on M.R.C.S.ENG., these evenings in order that I should be forthcoming to re- Medical Officer of Health for Stockport. lieve you in any difficulty in which you may be placed." THE latest addition to Professor E. Frankland's familiar series Unfortunately this promise often required to be acted upon, of annual reports to the Registrar-General on the quality of and it is to the honour of Dermott that he never failed to the water supplied by the metropolitan water companies pre- fulfil it. sents features of special interest and suggestiveness. Dermott was in every respect a thoroughly honest, straight- By graphic representations of the monthly fluctuations of forward, and painstaking man. Independent by nature, he contained organic matter, Professor Frankland demonstrates rarely squared himself by the opinions and feelings of others, the marked inferiority, in regard to chemical purity, of the and his rapidly-formed convictions were based as much upon raw river waters utilised in 1894 as compared with those used feeling as upon reasoning. He took an active part in the in 1893. and once more alludes to (a) the chemical superiority foundation of "The Medical Protection Assembly," which of the Lee over the Thames as a raw material, especially in was formed in 1843 after the new charter had been granted to times of flood; and (b) the greater chemical purity of the Lee the Royal College of Surgeons of England, and it was the in its upper as compared with its lower reaches. anxiety attending his relations with this Assembly which A second diagram contrasts the organic purity of the raw undoubtedly hastened his end. Thames water at Hampton with that of the average filtered Dermott's school was modelled more upon the Great Wind- water as delivered in London, and in this connection atten- mill Street or Webb Street Schools than upon Carpue's or tion is again directed to the fact that water impounded in Brookes's, for it aimed at giving a complete medical educa- times of severe floods may most seriously affect the quality of tion. The fee for perpetual attendance on the course of lec- the " supply as delivered "in the following month, even to the tures was £22, and the entries were so numerous that Mr. extent of making it during that month of worse quality from a Clarke says that when he joined the school its alumni chemical point of view than the raw river water passing the niumbered nearly 300. It suffered many migrations in the companies' works at the same time. Commenting upon this course of Dermott's life. The school was founded in Little remarkable state of things, Dr. Frankland, in his 1893 report, Windmill Street; it was transferred after a time to Chapel recommended the provision either of (a) some means of substi- Street, Wardour Street, and thence into a house in Great tuting the river for storedwater,whenever the chemical quality Pulteney Street. It was held for a time in the Westminster of the former is better than that of the latter, as roughly esti- Dispensary, in Gerrard Street, Soho, and later in Charlotte mated by observations of the colour in a two-foot tube; or of Street, Bloomsbury. This house was required by the Com- (b) sufficient storage to tide over the longe3t floods. This, it gnissioners of Metropolitan Improvements in 1845, and will be remembered, was one of the two conditions (the other Dermott was compelled to surrender his lease. He then being efflicient filtration) with which the late Royal Commis- moved into Bedford Square, where he died two years after- sion safeguarded their opinion that no danger exists of the wards. spread of disease by the use of drinking water derived from Dr. Ryan lectured in the original school for some time the Thames and Lee. Large though insufficient storage upon medicine. Hle was one of the physicians to the Western capacity appears, however, in this particular (chemical) re- Dispensary in Charles Street, Westminster, where most of spect, to be distinctly more disadvantageous than a relatively the students of the school attended as his pupils, for at this small amount, for certain companies who possessed compara- time the Apothecaries' Company received the certificate of tively little provision of this kind were actually enabled just fifteen months' attendance at a recognised dispensary as evi- after the floods of June and December, 1894, to deliver water dence that a candidate for its licence had passed through a of better quality than that supplied by the Chelsea Company; eulficient course of practical medicine. Ryan was editor of who, notwithstanding their much greiter storage capacity, the London Medical and Surgical Journal, but he eventually had obviously been unable to entirely exclude flood water, became involved in pecuniary difficulties, and died at a com- and had been compelled to use it afterwards. On the other paratively early age. hand, as regards bacterial purity, the deliveries of the com- John Epps, M.D., of the London University, lectured upon panies possessing least storage were, as might be expected, materia medica, chemistry, and botany. He was the eldest amongst the least satisfactory. son of a noted ham and beef shopkeeper in London, and Judged by the relatively low proportion of carbon to 'when the school broke up he took to the practice of homceo- nitrogen, the organic matter present in the waters was as ,pathy. usual found to be chiefly if not entirely of vegetable origin, In later years Tuson, Guthrie, Jewell, and Sigmond lectured, the directly conflicting results in this respect formerly and more than maintained the reputation of the Little Wind- obtained by the water companies' chemists having proved mill Street School. to be due to an error in the method of analysis adopted by the latter. A further discrepancy in regard to the Chelsea THE MANCHESTER MEDICAL SCHOOL. Company's water is explained by the fact that the supposed IDE F. W. JORDAN (Heaton Chapel, Stockport) writes: With reference to samples of this water collected for the companies' chemists your interesting article in the BRITISH MEDICAL JOURNAL of June 22nd were really taken inadvertently from the New River Com- on the Medical Schools of London, you refer, on page 1389. 1st line, to "'Dr. John Coode and Dr. Roget, who founded the Medcal School at pany's main. Manchester." This is a mistake. The Manchester Royal School of In regard to the softening of metropolitan water-both Medicine was founded by Mr. Joseph Jordan first in Marsden Street river and well-treatment with lime is regarded as the most and then in Chatham Street; it then amalgamated with one that had econom.cal method, unless it can be shown that less than 'been established in Pine Street. This last had been founded as the result of a split or quarrel, I believe. Mr. Joseph Jordan was licensed one-eightieth of the total supply is used for washing, for it by the College of Surgeons to deliver le-tures on Anatomy at his own entails only about one-eightieth of the expense incurred by qiouse in Bridge Street, which was fitted up with dissecting room and the private consumer in the shape of additional soap. museum. Believing with Koch and with American observers at Law- rence, Mass., that effici,nt sand filtration is practically a per- THE Medical Faculty of Cracow has proposed the name of fect safeguard against the introduction of cholera and typhoid fr. Galpzowski, the well known ophthalmic surgeon of Paris, bacilli into drinking water, Professor Frankland attaches the for the Chair of Ophthalmology in that University. highest hygienic importance to the bacterioscopic examina- THE Society of German Scientists and Physicians will hold tion of river-derived drinking waters as the only trustworthy its annual meeting this yearat Luibeck. The Societyhas now method by which their efficient filtration and bacterial purity a membership of 1,105. The Presidents for 1895 are Professors can be ascertained. To facilitate such examination in the Wislicenus. of Leipzig, von Ziemssen, of Munich, and metropolis he advocates the establishment of small bacte- Victor von Lang, of Vienna. riological laboratories at the various river-water intakes. It